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differential diagnosis > Screening for Endocrine and Metabolic Disease > Flashcards

Screening for Endocrine and Metabolic Disease Flashcards

1
Q

what makes up the endocrine system?

A

ductless glands that produce hormones

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2
Q

what is the function of the endocrine system?

A
  1. regulates:
    1. metabolism
    2. water/salt balance
    3. BP
    4. stress response
    5. sexual reproduction
  2. complex and integral interactions with the nervous system
  3. feedback mechanisms exist to keep hormones at normal levels
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3
Q

list the organs of the endocrine system

A
  1. hypothalamus
  2. pineal gland
  3. pituitary gland
  4. thyroid gland
  5. parathyroid gland
  6. thymus
  7. adrenal gland
  8. pancreas
  9. tests/ovaries
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4
Q

how are disorders of the endocrine system classified?

A
  1. primary → dysfunction of the gland itself
  2. secondary → dysfunction of an outside stimulus to the gland

results in either excessive or insufficient secretion of hormones

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5
Q

list S/S of endocrine or metabolic disease

A
  1. muscle weakness, myalgia, and fatigue → early manifestation of endocrine/metabolic disease
  2. bilateral carpal tunnel syndrome
    1. can be due to a thickening of transverse carpal ligament
  3. periarthritis and calcific tendonitis
    1. most often occurs in shoulders
  4. spondyloarthropathy and osteoarthritis
  5. hand stiffness/pain
    1. flexor tenosynovitis
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6
Q

T/F: dysfunction in the form of muscle weakness, myalgia and fatigue are always restored after treatment of underlying condition

A

FALSE

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7
Q

List what is included in the ROS for endocrine disorders

A
  1. hair and nail changes
  2. change in appetite, unexplained weight change
  3. fruity breath odor
  4. temp intolerance, hot flashes, diaphoresis
  5. heart palpitations, tachycardia
  6. HA
  7. low urine output, absence of perspiration
  8. cramps
  9. edema, polyuria, polydipsia, polyphagia
  10. unexplained weakness, fatigue, paresthesia
  11. carpal/tarsal tunnel syndrome
  12. periarthritis, adhesive capsulitis
  13. joint or muscle pain (arthralgia, myalgia), trigger points
  14. prolonged DTRs
  15. sleep disturbance
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8
Q

list endocrine pathologies associated with each organ

A
  1. Pituitary gland → Acromegaly
  2. Adrenal glands → Addison’s disease and Cushing’s syndrome
  3. Thyroid gland → Hyperthyroidism/Grave’s disease, and Hypothyroidism
  4. Pancreas → diabetes mellitus
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9
Q

what is Acromegaly?

A

Problem with pituitary gland

hypersecretion of growth hormone (GH) resulting in abnormal enlargement of the extremities of the skeleton

  • most commonly affects enlargement of face, jaw, hands, feet
  • occurs in adults usually due to a pituitary gland tumor
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10
Q

Clinical S/S of Acromegaly (5)

A
  1. Bony enlargement (face, jaw, hands, feet)
  2. Carpal tunnel
  3. hand pain and stiffness
  4. myopathy and poor exercise tolerance
  5. degenerative arthropathy (large joints)
  6. amenorrhea
  7. DM
  8. diaphoresis
  9. HTN
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11
Q

what is the cause of Addison’s disease?

A

adrenal insufficiency → hyposecretion of adrenal gland

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12
Q

clinical S/S of Addison’s disease (5)

A
  1. dark pigmentation of the skin, especially mouth and scars
  2. progressive fatigue (improves with rest)
  3. hyperkalemia → results in generalized weakness and muscle flaccidity
  4. arthralgia, myalgias (secondary only)
  5. tendon calcification
  6. hypotension
  7. GI disturbances
  8. anorexia and weight loss
  9. N/V
  10. hypoglycemia
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13
Q

what is Cushing’s syndrome?

A

hypersecretion of cortisol by adrenal cortex

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14
Q

what are the effects of cortisol on connective tissue?

What else does cortisol negatively effect that might make early signs of infection not present?

A
  1. poor wound healing
  2. generalized muscle weakness and wasting
  3. osteoporosis

cortisol suppresses inflammatory response of the body

◦Any unexplained fever without other symptoms should warrant MD referral

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15
Q

how does cortisol influence inflammation?

A

cortisol suppresses the inflammatory response of the body; therefore early signs of infection may not be present

any unexplained fever w/o other symptoms should warrant MD referral

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16
Q

Clinical S/S of Cushing’s syndrome

A
  1. Moonface appearance
  2. Buffalo hump
  3. protuberant abdomen with accumulation of fatty tissue and stretch marks
  4. muscle wasting and weakness, thin extremities
  5. decreased bone density, kyphosis, back pain
  6. HTN
  7. easy bruising and slow wound healing
  8. psychiatric and/or emotional disturbance
  9. impaired reproduction function, masculinizing effects
  10. DM
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17
Q

what is hyperthyroidism (aka Grave’s disease)?

A

disorder in which the thyroid secretes excessive amounts of thyroid hormone

results in generalized elevation in body metabolism effecting every system in the body

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18
Q

MSK implications of hyperthyroidism (Grave’s disease)

3

A
  1. periarthritis → most commonly in the shoulder and can progress to adhesive capsulitis
  2. acute calcific tendonitis of the wrists
  3. proximal muscle weakness and myopathy (pelvic girdle/thigh muscles)
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19
Q

Clinical S/S of hyperthyroidism (Grave’s disease)

A
  1. Exophthalmos
  2. enlarged thyroid
  3. tachycardia
  4. weight loss
  5. diarrhea
  6. warm skin, sweaty palms
  7. hyperreflexia
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20
Q

what is a thyroid storm?

A

rare, life threatening complication of hyperthyroidism that can present when the disease is untreated or the disease is incorrectly treated

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21
Q

what are some precipitating factors of a thyroid storm?

A

trauma, infection, surgery

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22
Q

Symptoms of a thyroid storm

A
  1. severe tachycardia w/HF
  2. shock
  3. hyperthermia (up to 105.3 degrees F)
  4. restlessness
  5. agitation
  6. abdominal pain
  7. N/V
  8. coma
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23
Q

what is hypothyroidism?

A

the under production of thyroid hormone creating a general depression of body metabolism

women are 10x more likely than men to have hypothyroidism

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24
Q

MSK implications of hypothyroidism

A
  1. Carpal tunnel syndrome
    1. flexor tenosynovitis often accompanies
    2. usually presents bilaterally
  2. Proximal muscle weakness
    1. sometimes accompanied by aches, cramps, stiffness
    2. development of persistent myofascial trigger points
    3. apparent association between hypothyroidism and fibromyalgia
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25
Q

Clinical S/S of hypothyroidism

A
  1. excessive fatigue and drowsiness
  2. dry skin, ichthyosis
  3. thin and brittle hair and nails
  4. hoarseness and thick, slurred speech
  5. weight gain
  6. HA
  7. cold intolerance
  8. edema of the extremities
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26
Q

what is diabetes?

A

deficient or defective insulin action in the body, characterized by hyperglycemia

Type I → little or no insulin produced by pancreas

Type II → defective insulin and/or impaired cell receptor binding of insulin

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27
Q

how is Diabetes Diagnosed?

A
  • two different days of fasting blood glucose levels at >126
  • values >100 are considered “pre-diabetic”
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28
Q

what can PTs offer clients with pre-diabetes or diabetes?

A

education regarding physical activity and exercise as a means of lowering their risk of diabetes or reducing the risk of complications from diabetes

29
Q

list several medications that influence blood glucose levels and contribute to hyperglycemia

A
  • corticosteroids → have glucogenic effect
  • epinephrine, glucocorticoids, and growth hormone
30
Q

list several times that controlled diabetes can become uncontrolled

A

times of stress including:

  1. surgery
  2. trauma
  3. pregnancy
  4. puberty
  5. infectious states
31
Q

Clinical S/S of diabetes (3)

A
  1. Xanthomas
  2. Numbness/tingling in hands and feet
  3. wounds that are slow to heal
  4. fatigue and weakness
32
Q

list physical complications of diabetes (4)

A
  1. impaired wound healing/infection
  2. neuropathy
    1. diabetic neuropathy
    2. carpal tunnel syndrome
    3. charcot’s joint
  3. periarthritis
  4. hand stiffness
    1. limited joint mobility syndrome
    2. flexor tenosynovitis
    3. Dupuytren’s syndrome
    4. complex regional pain syndrome
  5. atherosclerosis
33
Q

what is the most common chronic complication of long-term diabetes?

A

diabetic neuropathy

can affect the PNS, CNS, or ANS

(usually PNS develops first)

34
Q

differentiate between peripheral sensory and motor neuropathies that are present in diabetes

A
  1. peripheral sensory neuropathies
    1. most common
    2. results in burning, numbness, and/or sensitivity to touch in the feet and hands (stocking/glove distribution)
  2. peripheral motor neuropathies
    1. results in weakness, atrophy, and foot drop
    2. decreased balance, absence of DTRs
35
Q

what is Charcot’s joint ?

A

aka neuropathic arthropathy

  • refers to insidious progressive degeneration of a joint that’s marked by bony destruction, bone resorption, and eventual deformity
36
Q

describe Charcot’s joint

what does it increase the liklihood of?

A
  • loss of proprioception and sensation predisposes joints to repeated trauma and progressive joint destruction
  • results in hand, shoulder, and foot disorders
  • increases the likelihood of ulceration development
37
Q

what is periarthritis?

A

inflammation of the structures around a joint

  • may regress, remain stable, or progress spontaneously
  • higher incidence of adhesive capsulitis
38
Q

describe hand stiffness resulting in limited joint mobility in diabetes

A

syndrome of limited joint mobility (SLJM or LJM)

  • painless stiffness and limitation of the finger joints
  • development of flexion contractures
39
Q

describe stiff hand syndrome resulting from diabetes

A
  1. seen more frequently with Type I diabetic and those with poorly controlled blood glucose levels
  2. paresthesia progressing to pain, subcutaneous tissue changes
40
Q

what is flexor tenosynovitis?

A

accumulation of excessive dermal collagen in the tendon sheath

results in formation of nodules

41
Q

describe Dupuytren’s contracture

A

characterized by formation of flexion contracture and thickening band of palmar fascia

  • strong association with DM
  • usually involving 3rd and 4th digits
  • presentation of pain and decreased ROM
42
Q

describe chronic regional pain syndrome (CRPS)

A
  • may develop in pts with DM
  • in hands or feet
  • can spontaneously improve or result in permanent loss of function
43
Q

what is the PT’s role in screening with diabetes?

A
  1. assess for neuropathy
  2. assess for signs of neuropathic arthropathy
  3. monitor for S/S of changes in blood glucose levels during exercise
  4. monitor vital signs
  5. conduct periodic LE vascular examination
  6. screen for depression
  7. encourage regular screenings with other disciplines
44
Q

exercise-related considerations for diabetes

  • what blood glucose level should you hold exercise at?
  • What blood glucose level should you eat a snack at?
A
  1. Blood glucose >250 mg/dL = hold exercise
  2. Blood glucose <100 mg/dL = eat snack prior to exercise
    1. recommendation to eat 10-15 gram carb snack
    2. retest blood glucose prior to initiation of exercise
45
Q

Clinical S/S of DKA

A
  1. fruity breath
  2. gradual onset
  3. thirst
  4. hyperventilation
  5. lethargy/confusion
  6. coma
  7. muscle/abdominal cramps
  8. polyuria/dehydration
  9. flushed face
  10. hot/dry skin
  11. elevated temperatures
  12. blood glucose >300
  13. serum pH <7.3
46
Q

what blood glucose level indicates hypoglycemia?

A

less than 70 mg/dL

treat via immediate administration of sugar (10-15 grams); clinics should keep immediate-acting glucose sources available

47
Q

Clinical S/S of hypoglycemia

A
  1. sympathetic activity
    1. pallor, perspiration
    2. irritability/nervousness
    3. weakness, hunger, shakiness
  2. CNS activity
    1. HA
    2. double/blurred vision
    3. slurred speech
    4. fatigue
    5. numbness of lips/tongues
    6. confusion
    7. convulsion/coma
48
Q

Diabetes key points to remember

A
  1. corticosteroid meds have glucogenic effect and should be monitored
  2. exercise must be carefully planned b/c sig complications can result from strenuous exercise
    1. avoid exercise during peak insulin dosage for those who are insulin dependent
    2. test blood glucose immediately with lethargy or confusion
49
Q

T/F: insulin requirements often increase for clients under physical, emotional, or psychological stress

A

TRUE

and symptoms may present even though diabetes normally controlled

50
Q

list metabolic pathologies

A
  1. Metabolic disorder → Gout
  2. Metabolic bone disease → Osteoporosis
51
Q

what is Gout?

A

a disease that results in tiny uric acid crystals forming that collect in the joints, triggering a painful inflammatory response

uric acid is changed into urate crystals and deposited into joints (90% being the 1st MTP)

52
Q

describe the presentation of Gout

A
  1. acute monoarticular arthritis
  2. exquisite pain and sensitivity
  3. followed by redness, swelling and/or low grade fever
53
Q

what should you do if a pt is being treated for gout and has recurrent symptoms?

A

REFER

54
Q

Clinical S/S of Gout

A
  1. Joint pain and swelling; especially 1st MTP
  2. redness
  3. fever and chills
  4. malaise
  5. tophi
55
Q

what is osteoporosis?

A

decreased mass per unit volume of normally mineralized bone compared with age- and gender-matched controls

56
Q

describe prevention of osteoporosis

A

prevention and education begins in childhood and early adolescence

diet and bone building exercise are essential

57
Q

postmenopausal osteoporosis particularly involves _________

A

the vertebrae

58
Q

describe early signs and the cardinal signs (3) of osteoporosis

A
  1. mid to severe back pain and loss of height may be the only early signs observed
  2. cardinal signs of established osteoporosis
    1. bone fracture
    2. pain
    3. deformity
59
Q

Risk factors for osteoporosis

A
  1. Caucasian or Asian female
  2. postmenopausal (older than 65)
  3. early or surgically induced menopause
  4. family history of osteoporosis
  5. family history of personal history of fractures
  6. lifestyle of smoking, excessive alcohol intake, inadequate calcium, little or no WBing exercise
  7. prolonged exposure to thyroid, corticosteroid, NSAID, and anti-seizure medications
  8. thin, small-framed (125 lbs)
  9. chronic disease that affect kidneys, lungs, stomach, and intestines
60
Q

Clinical S/S of osteoporosis

A
  1. Back pain → episodic, acute low thoracic/high lumbar pain
  2. Compression fracture of the spine (with postmenopausal)
  3. Bone fractures
  4. Decreased height (>1 inch shorter than max height)
  5. severe kyphosis, dowager’s hump
61
Q

Clues to recognize osteoporosis

A
  1. severe, localized pain to fracture site
  2. aggravating factors
    1. prolonged sitting
    2. bending
    3. Valsalva maneuver
  3. not accompanied by sciatic or nerve root impingement pain
  4. rib or spinal deformity, dowager’s hump
  5. loss of height
62
Q

how do you interpret the Osteoporosis screening evaluation form?

A

increased risk for developing osteoporosis with a “yes” answer to 3 or more questions

this warrants a MD referral

63
Q

list nonmodifiable risk factors for vertebral compression fractures

A
  1. advanced age
  2. female gender
  3. Caucasian race
  4. presence of dementia
  5. Susceptibility to falling
  6. history of fracture in adulthood
  7. history of fracture in a 1st degree relative
64
Q

list modifiable risk factors for vertebral compression fractures

A
  1. alcohol and/or tobacco use
  2. presence of osteoporosis and/or estrogen deficiency
  3. early menopause
  4. frailty
  5. impaired eye-sight
  6. insufficient physical activity
  7. low body weight
  8. calcium and/or vitamin D deficiency
65
Q

Clinical presentation of Vertebral compression fractures

A
  1. back pain → highest incidence T7-8 and T12-L1
  2. lying in supine relieves
  3. standing/walking aggravates
  4. tenderness to palpate over area of fracture
  5. may note increased thoracic kyphosis
66
Q

what is the MOI of vertebral compression fractures

A

typically secondary to trauma

  • however, this could be as simple as sneezing or lifting a small object
  • may also occur w/o any hx of increased force on the spine
  • intensity and duration of pain may vary
67
Q

list clues in PMH to screen for endocrine and metabolic disease

A
  1. previously diagnosed endocrine or metabolic disorder
  2. bilateral carpal tunnel syndrome
  3. proximal muscle weakness
  4. periarthritis of the shoulder(s)
  5. long term use of corticosteroids
68
Q

list associated S/S that are clues to screen for endocrine and metabolic disease

A
  1. arthralgia
  2. hand pain and stiffness
  3. muscle weakness
  4. with accompanying S/S of endocrine/metabolic disorders
69
Q

guidelines for immediate medical attention

A
  1. with diabetes
    1. confusion
    2. lethargy
    3. changed mental function
    4. profuse sweating
    5. signs of DKA
  2. signs of thyroid storm

differential diagnosis (14 decks)

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